Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations

Abstract

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged ≥ 20 years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, and the technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Keywords: Diabetes; Heart disease; Hypertension; Recommendations; Renal disease; Stroke.

Fig. 1

A SMART VIEW (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS): schematic of the Ten recommendations for accelerating hypertension and diabetes control to reduce stroke, heart, and renal disease in Cameroon through partnerships and collaborations

Fig. 2

Consensus protocol for the management of uncomplicated hypertension at the PHC Center in Cameroon. Please note that this protocol is not suitable for patients who are pregnant or those with complicated hypertension (requiring referral to specialist***). ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, BP blood pressure, CCB calcium-channel blocker, DASH Dietary Approaches to Stop Hypertension, PHC Primary Health Care, SBP systolic blood pressure, SR sustained release. *Fasting blood sugar, urinalysis, serum sodium, potassium, creatinine, uric acid, and total cholesterol, electrocardiogram, fundoscopy. **Approximately two-thirds of patients are non-adherent. Antihypertensive drugs are generally well tolerated and effective (5–10% of patients receiving amlodipine will report pedal edema and 5%–10% receiving ACEIs may experience a chronic cough (necessitating a switch to ARBs). ***Internist or cardiologist (for heart failure), neurologist (for stroke), and nephrologist (for renal failure). ^†Treatment with a single pill combination is typically preferred

Fig. 3

Proposed algorithm for the management of type 2 diabetes in Cameroon. Please note that this protocol is not suitable for patients who are pregnant or those with complicated diabetes (requiring referral to specialist). ^†Healthy diet, regular physical activity, and weight management. FPG fasting plasma glucose, HbA1c glycated hemoglobin, NPH neutral protamine Hagedorn, PPG postprandial glucose, WHO World Health Organization